title: Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: a pilot randomized clinical trial.
abstract: BACKGROUND
  Plantar heel pain syndrome (PHPS) is a common foot disorder; however, there is limited clinical evidence on which to base treatment. Repeated clinical observations indicating heel pain during heel rise and minisquat on the affected leg, involving activation of posterior calf muscles, formed the basis of this study.
  
  
  OBJECTIVE
  To compare deep massage therapy to posterior calf muscles and neural mobilization with a self-stretch exercise program (DMS) to a common treatment protocol of ultrasound therapy to the painful heel area with the same self-stretch exercises (USS).
  
  
  METHODS
  Patients with PHPS were assigned to a program of 8 treatments over a period of 4-6 weeks in a single-blind randomized clinical trial. Functional status (FS) at admission and discharge from therapy as measured by the Foot & Ankle Computerized Adaptive Test was the main outcome measure.
  
  
  RESULTS
  Sixty-nine patients were included in the trial (mean age 53, standard deviation (SD) 13, range 25-86, 57% women), 36 received DMS treatment and 33 with USS. The overall group-by-time interaction for the mixed-model analysis of variance (ANOVA) was found statistically significant (p=0.034), with a change of (mean (confidence interval, CI)) 15 (9-21) and 6 (1-11) FS points for the DMS and USS groups, respectively.
  
  
  CONCLUSIONS
  Data indicated that both treatment protocols resulted in an overall short-term improvement, however, DMS treatment was significantly more effective in treating PHPS than USS treatment.
authors.affiliation: Physical Therapy Service, Maccabi Healthcare Services, Shpeigel 3, Petach Tikva, Israel. Electronic address: saban_b@mac.org.il.
authors.forename: Bernice
authors.initials: B
authors.lastname: Saban
authors.affiliation: Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Deutscher
authors.affiliation: Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tomer
authors.initials: T
authors.lastname: Ziv
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D036981:Fasciitis, Plantar / Q000628:therapy*; D005260:Female; D006365:Heel; D006801:Humans; D008297:Male; D008405:Massage; D008875:Middle Aged; D052580:Muscle Stretching Exercises / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D013577:Syndrome; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
keywords: Deep massage; Functional status; Neural mobilization; Plantar heel pain syndrome